As early as 80 years ago, people have used Vaseline, alum, ceramics, gold, silver, platinum, celluloid, ivory, and even black sea stone, nails, duck breast bone, toothbrush handle, etc., as filling materials to do the rectification of saddle nose, rhinoplasty beauty. The above materials were abandoned either because of excessive irritation and high discharge rate; or because of brittle quality and easy to break; or because of expensive and difficult source, etc. In the 1920s, liquid paraffin was widely used as a filler for several decades until it was widely reported that the material was prone to cause paraffin tumors, and then the use was stopped.
Introduction
With the rapid development of the chemical industry in the past three or four decades, a variety of polymer materials have been introduced for plastic surgery outside the various shapes of silicone rhinoplasty material section and achieved good results. But for rhinoplasty, because the discharge rate is high, the long-term effect is still difficult to determine, so many doctors advocate the use of autologous bone tissue or cartilage tissue to do rhinoplasty materials. However, the application is also limited by the absorption of bone tissue and the increase of pain of the patient. Clinical application shows that the materials used for rhinoplasty, whether autologous or allogeneic, active or inactive, natural or chemically synthesized, all have certain advantages and disadvantages, and can only be used according to the specific situation and discretion.
Rhinoplasty materials
Autologous bone tissue
Autologous bone tissue rhinoplasty is one of the early materials used in rhinoplasty. Its main advantage is that after transplantation, the rhinoplasty prosthesis material is easily viable and will not be rejected. The autologous bone tissue used for rhinoplasty is mostly taken from the iliac bone, but also from the ribs, tibia, skull, etc. Autologous bone rhinoplasty has problems such as poor elasticity of bone tissue and difficulty in shaping, so the postoperative appearance does not look very natural, the autologous bone is not convenient to take, the bone source is limited, and cutting may cause the second pain of the patient, and even complications. In the long term, bone resorption can also occur, resulting in external morphological changes, which is difficult for the patient to accept. At present, it is less frequently used for rhinoplasty. However, for the correction of complex nasal deformity or severe saddle nose, autologous bone graft is still needed.
Autologous cartilage tissue
Autologous cartilage tissue is the more commonly used autologous tissue in rhinoplasty. Its main characteristic is that it does not have blood vessels and is easily viable. After implantation, it has no stimulating effect on the tissue and can maintain its original volume and cellular form for a long time, so it can be easily cut into the required size and form. Like autologous bone tissue rhinoplasty, autologous cartilage tissue implantation rhinoplasty also has the possibility of absorption and deformation. The surgery also causes trauma other than the nose, which is difficult to accept for patients without specific deformities. The most commonly used autologous cartilage for rhinoplasty is rib cartilage, followed by auricular cartilage and nasal septal cartilage. The former bone source is abundant and is suitable for serious deformity and large amount of bone required; the latter is suitable for mild saddle nose or low nasal tone due to limited bone source.
Allogeneic tissue
Allogeneic tissue rhinoplasty refers to the use of fresh cadaveric bone and cartilage tissue, after special treatment, as rhinoplasty material for rhinoplasty. After rhinoplasty, the allograft bone and cartilage only play a temporary mechanical support role and are eventually replaced by autologous bone, which is gradually abandoned due to the difficulty in sourcing allograft tissue and the difficulty in ensuring the quantity and quality.
Allogeneic tissues
At present, the allogeneic tissues used for rhinoplasty are mainly: bovine septal cartilage, bovine rib cartilage and calf sternum, which can be used for human rhinoplasty after special treatment. The advantage is that the material is easily sourced, abundant and easily shaped. The disadvantage is that although specially treated, there is still a weak individual antigenicity and the possibility of rejection; there are different degrees of absorption, so the long-term effect is not very satisfactory. Since it can be used in human body only after special treatment, there are difficulties in universal application. At present, there are still relatively few people who apply allogeneic tissues for rhinoplasty.
Biological tissue substitutes
With the development of science and technology and the progress of the chemical synthesis industry, biological tissue substitutes suitable for human body have become a reality. The progress of tissue substitutes will play a role in promoting the development of aesthetic plastic surgery. Into the 70s, the common biological tissue substitutes are: liquid silicone, ivory, dental materials, solid silicone, artificial bone materials and expanded polytetrafluoroethylene. Liquid silicone in China, in the late 70s and early 80s, widely used, liquid silicone injection rhinoplasty, clinical observation proved that after surgery can cause lasting redness of the nose, swelling, skin necrosis of the nose and flesh tooth swelling, and even disfigure the face. And liquid silicone can spread around to infiltrate and penetrate, without clear boundaries and difficult to deal with. The United States has strictly prohibited the use. Many domestic scholars advocate the prohibition of use or caution.
Ivory
Ivory has good biocompatibility and generally does not cause rejection, but it is gradually abandoned for rhinoplasty because of its hardness, difficulty in sculpting and shaping, and protection of animals.
Odontogenic materials
The tooth-making material used for rhinoplasty is polymethacrylic acid, methyl ester (PMMA), which is one of the earlier solid-type biological tissue substitutes used for rhinoplasty. It has good biocompatibility and needs to be blended when used for rhinoplasty, which is very easy to contaminate. If the contamination is not completely removed before surgery, it will easily cause complications such as infection, pain and rejection, and its prosthesis preparation is more complicated and relatively difficult to operate, so it is less used now.
Solid silicone
At present, the commonly used material for rhinoplasty is polymer silicone. It was used as early as 1972, and after more than 20 years of observation, although its complication rate can reach 5%-20%, it is still one of the preferred clinical rhinoplasty materials because of its good biocompatibility and low price. Its main disadvantage is that it cannot establish blood circulation with the body and form tissue connection, but only fibrous tissue envelope, so it can penetrate the skin at the tissue weakness, and due to the contracture of the fibrous envelope, it can cause the projection of the body surface of silicone prosthesis, and affect the appearance effect.
Artificial bone material
Mainly refers to hydroxyapatite. It is the main inorganic component of human bone tissue, thus its biocompatibility is good, non-toxic, non-teratogenic, non-allergenic and non-carcinogenic side effects. It has been widely used in dentistry and orthopedics. From the mid-1980s, it was used for rhinoplasty, which is simple to operate and easy to shape, especially for those with low nasal bridge, the postoperative effect is particularly satisfactory. Because of its non-supporting effect, it is less effective for those with low nasal tip.
Expanded polytetrafluoroethylene (ePTFE)
From the medical point of view, it is currently the most ideal biological tissue substitute. Due to its good biocompatibility and unique microporous structure, non-toxic, non-cancerous, non-allergenic and other side effects, and human tissue cells and blood vessels can grow into its microporous, forming tissue connections, as in the case of autologous tissue. The results of rhinoplasty are very satisfactory. ePTFE rhinoplasty material was introduced to China from the United States in 1995, but its price is expensive, which affects its universal application.
MEDPOR Biomaterial
Made of linear high-density polyethylene material with very good histocompatibility. It is easy to sculpt and shape, has a certain flexibility and relative incompressibility, and has relatively large voids that allow soft and bone tissue to grow in, thus having a certain osteoconductive effect. The results of basic medical research have shown that MEDPOR biomaterials have no significant toxic effects on biological tissues and cells. MEDPOR
MEDPOR biomaterials are shipped sterile.
MEDPOR biomaterials have been clinically proven in the United States since 1972 and were approved by the FDA in 1984 after a long period of extensive clinical observation. Over the past two decades, MEDPOR biomaterials have proven themselves to be suitable for plastic surgery, ophthalmology, brain surgery, and dentistry, with excellent postoperative results. The product has been clinically used in China since 1996 and has been registered by the State Drug Administration of China. It can be used as a safe filling stent in rhinoplasty surgery. In conclusion, the choice of rhinoplasty materials should be based on your own conditions, economic conditions, combined with the doctor’s diagnosis and tips, before making a decision.
Rhinoplasty materials – ideal materials
From the medical point of view, silicone material is the most ideal biological tissue substitute, which was mainly used for vascular reconstruction during human organ transplantation. Silicone materials are the most compatible with the human body, non-toxic, non-cancerous, non-allergenic and do not need to be replaced for life.
Silicone prosthetic materials can be used that have been prefabricated into various shapes and models with nasal tip, nasal wing, and nasal columella, etc. There are two commonly used types, one is willow leaf-shaped and the other is L-shaped. Although rhinoplasty is a simple procedure, improper handling will increase the chances of postoperative movement of the prosthesis, distortion, infection, rejection, and even cause skin breakdown, necrosis, erosion and other complications.
Compared with the expansion material, silicone material has the following advantages.
1, the texture and feel of silicone material is very close to the normal nasal tissue, beautiful and natural after rhinoplasty, it is difficult to detect.
2, silicone material has a special microporous structure, the body tissue cells and blood vessels can grow into it, forming a tissue connection, as perfect as the autologous tissue.
3, silicone material does not move, does not deform, and is integrated with the nasal body tissue, and it is impossible to wear out the skin.
4.The silicone material does not have the “transparent feeling” of silicone.
5, silicone material is light in weight, no sense of falling. The biggest problem with the expansion material rhinoplasty is the higher price, the plastic surgeon’s surgical design skills, material sculpting skills are higher.
Rhinoplasty material development history
Rhinoplasty is popular in the East, the first person and year are difficult to prove. In the early days, autologous iliac bone and rib cartilage were mainly used as rhinoplasty materials, and ivory was also used as a tissue substitute. Because of the painful surgery and the need for hospitalization when using autologous iliac bone or rib cartilage, the application of tissue substitutes was developed more rapidly. Early attempts at tissue substitutes were numerous and mixed, as well as the application of some materials that seemed to border on the absurd. Materials that have been used for rhinoplasty include: paraffin oil, petroleum jelly, platinum, zinc, silver, ivory toothbrush handles, nails, celluloid, ceramics, animal bone, plexiglass, etc. Paraffin oil was once popular in the 1920s and was widely used for procedures such as rhinoplasty, breast augmentation and filling depressions. Due to the mobility of paraffin oil in the interstitial space and tissue rejection, it could cause many complications and was difficult to stabilize the shape, so it was soon eliminated or explicitly banned. Some other materials were eliminated either because of excessive rejection and complications or because of their hard texture and difficulty in sculpting and shaping. However, some materials, such as ivory, are still occasionally used [1].
Domestic status
In China, in the late 1980s, due to the confusion of medical aesthetic management, some charlatans returned to their old practice and used paraffin oil injection, which had long been eliminated, as a new method for rhinoplasty and breast augmentation, resulting in many complications.
In 1955, Nishihata first applied solid silicone rubber material for nose augmentation, which was successful. Solid silicone rubber has stable performance, easy to sculpt, low incidence of tissue rejection, non-toxic, non-carcinogenic, and easy to remove once complications occur. This method was soon recognized and welcomed by doctors all over the world. To date, solid silicone rubber is still the main prosthetic material used for rhinoplasty.
In 1963, Counay and Goulian reported success with liquid silicone rubber rhinoplasty. Because liquid silicone rubber can be injected for rhinoplasty,[2] it can be shaped as desired, with ideal contouring, no surgery and less pain, and was once popular worldwide. However, after more than 10 years of clinical practice, it was found that liquid silicone rubber is also prone to rejection, and once complications occur, the nasal body cannot be easily removed, often resulting in heavy adverse consequences. The occurrence of skin ulceration and necrosis of the dorsum of the nose, resulting in deformity, has been common. The United States in the 1980s has been explicitly banned the use. Although not explicitly prohibited in China, but the Chinese Society of Plastic Surgery has repeatedly called for the cessation of use.
In the early 1990s, some manufacturers introduced injectable liquid hydroxyapatite nose job. Hydroxyapatite, also known as artificial bone, has been used in orthopedics for many years, with better results, low tissue reaction and easy shaping. However, because liquid hydroxyapatite can spread along the tissue gap, the shape is not very regular after solidification, and it is difficult to completely remove the prosthesis once rejection and other complications occur. Therefore, the promotion of the use of this method has been limited.
With the improvement of medical understanding and the development of medical materials, the type and quality of non-tissue substitutes will be developed and improved. So far, rhinoplasty materials are still dominated by high-quality silicone rubber materials.
Tips
Rhinoplasty materials Choose according to your own conditions
1, autologous rib cartilage is suitable for people with severe saddle nose or heavy rejection reaction to artificial tissue materials, which has excellent tissue compatibility and is not easily absorbed; however, the residual incision scar on the chest, which is slightly traumatic and easy to bend and deform part of rib cartilage after transplantation, is its disadvantage. And fascia and part of the ear cartilage transplantation is also suitable for rhinoplasty.
2, tumescent polytetrafluoroethylene soft texture, compared with other artificial implants, its flexibility is closer to soft tissue, is an inert tumescent polymer, its interior consists of many nodes, knots and knots between the tiny fibers multi-directional three-dimensional intertwined together, and is ultra-micro porous structure, with solid and soft and allow the characteristics of tissue growth into.
3.Solid silicone prosthesis is the most commonly used material for rhinoplasty in China, which has the following advantages: ① stable performance, low irritation, non-absorption, long-term preservation in the tissue; ② beautiful shape, easy to shape, no deformation; ③
The price is cheap, the amount of material taken is not limited, and the pain of cutting and taking autologous bone is not required, so it is easily accepted by the patient. The disadvantage of silicone is that if deformation, deviation of the prosthesis and other adverse reactions occur, silicone will also cause adhesions to the tissue, and it is not very easy to remove. Comparison of silicone and pontic
The first from the tissue compatibility of the two materials to compare. The puffy material and silicone prosthesis are better, high and low temperature resistance, chemical stability, corrosion resistance, tissue compatibility are good, non-toxic, non-cancerous, non-teratogenic. But there are very few people will have rejection of both, due to the special structure of the material, blood vessels and nerves can gradually grow into the interior of the bulge, so that the bulge and human tissue grow together, while silicone prosthesis is not and human tissue grow together, implanted in the body, the local may be a mild one-time inflammatory reaction, the late formation of a thin layer of fiber around the capsule, is currently the most used in rhinoplasty, the It is one of the most used and effective materials in rhinoplasty.
The second comparison from the two intraoperative plasticity. Although the expansion material has a certain degree of flexibility, but the elasticity and three-dimensional sense is poor, not suitable for sculpting and shaping, used to support the nasal column, nasal tip effect is not good. Silicone prosthesis itself has the basic shape of the nose and can be sculpted at will on its basis. Silicone rubber can be prefabricated into various shapes and models of nasal prosthesis with nasal tip, nasal wing, nasal column, etc. The commonly used ones are “L” shape, “T” shape and willow leaf shape. Flexibility and elasticity is better, three-dimensional sense of strong.
The third expansion material in the case of tissue growth into the original will lose its flexibility, become very solid, which makes its appearance and feel lose the real sense of the nose is relatively dull, unnatural. The silicone implant does not have such a problem, it will not change its shape over time, there will be no tissue growth, and there will be no change in feel. Instead, the toughness and elasticity are more stable and therefore very natural.
Fourthly, because of the characteristics of the tumescent material will have tissue growth into, so this brings trouble to the patient’s secondary surgery, through the observation we found that the longer the tumescent material in the body, the more detrimental to the removal of the tumescent material. Due to the growth of tissue into the body, the expansion body and human tissue combined tightly, the formation of the cavity is becoming smaller and smaller, so if you take out the expansion body material is like taking out a piece of their own tissue, the damage to the surrounding tissue is self-evident. Silicone prosthesis in the body does not exist in the tissue growing together in the trouble, the general surgery into the cavity of the prosthesis will not change much, the prosthesis in the body is like wearing a piece of clothing wrapped in a layer of fiber capsule, so take out the silicone prosthesis is as simple as taking out a thing from the pocket, will not produce any damage to the surrounding tissue.
Fifth, the cost of the expansion material is generally about two times the silicone material, but the price of surgery is equivalent to three to five times the silicone material, so that is why the expansion body has been strongly promoted by some plastic surgery institutions.